Dacryoscintigraphy with SPECT-CT in the investigation of epiphora

Learning Objectives 1. To review anatomy and physiology of the lacrimal system 2. To understand causes of epiphora and their underlying pathophysiology 3. To summarize the imaging evaluation of the nasolacrimal duct system 4. To review the use of dacryoscintigraphy in the workup of epiphora with emphasis on SPECT-CT.

Epiphora is a common condition characterized by excessive tearing of one or both eyes. Causes include excess production of tears due to occular irritation or inflammation, as well as obstruction of the tear outflow tract. In patients in whom epiphora is not caused by excessive tear production or complete duct obstruction, dacryoscintigraphy allows assessment of a functional causes of nasolacrimal duct obstruction, performed under physiological conditions. Addition of SPECT-CT to planar scintigraphy the exam allows for improved anatomic correlation and characterization of obstruction. We present the typical findings of nasolacrimal duct obstruction on dynamic, planar, and SPECT-CT in a spectrum of etiologies of epiphora. In addition, current standard of care is reviewed.